1
|
Ng YX, Cheng LJ, Quek YY, Yu R, Wu XV. The measurement properties and feasibility of FRAIL scale in older adults: A systematic review and meta-analysis. Ageing Res Rev 2024; 95:102243. [PMID: 38395198 DOI: 10.1016/j.arr.2024.102243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
Frailty is a prevalent condition amongst older adults, significantly affecting their quality of life. The FRAIL tool has been purposefully designed for clinical application by assisting healthcare professionals in identifying and managing frailty-related issues in older adults, making it a preferred choice for assessing frailty across diverse older populations. This review aimed to synthesize the measurement properties and feasibility of FRAIL. Guided by COSMIN guidelines, seven databases were searched from inception to 31 Mar 2023. The measurement properties were extracted for quality appraisal of the populations in the studied samples. Where possible, random-effects meta-analysis and meta-regression were used for quantitative synthesis. Eighteen articles containing 273 tests were drawn from 14 different populations. We found that populations testing for criterion validity had high-quality ratings, while construct validity ratings varied based on health status and geographical region. Test-retest reliability had sufficient quality ratings, while scale agreement had sufficient ratings in only four out of 14 populations tested. Responsiveness ratings were insufficient in seven out of eight populations, with inconsistent ratings in one population. Our analysis of missing data across three articles showed a 16.3% rate, indicating good feasibility of the FRAIL. FRAIL is a feasible tool for assessing frailty of older adults in community settings, with good criterion validity and test-retest reliability. However, more research is needed on construct validity and responsiveness.
Collapse
Affiliation(s)
- Yu Xuan Ng
- Alexandra Hospital, National University Health System, Singapore
| | - Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yu Yi Quek
- Alexandra Hospital, National University Health System, Singapore
| | - Ruby Yu
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore.
| |
Collapse
|
2
|
Makwana NR, Ram RV, Yogesh M. Screening of Hospitalized Elderly Patients for Frailty and Associated Co-morbid Conditions in Western Gujarat in India. J Family Med Prim Care 2024; 13:890-895. [PMID: 38736826 PMCID: PMC11086788 DOI: 10.4103/jfmpc.jfmpc_1176_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 05/14/2024] Open
Abstract
Background Older patients admitted to hospitals have a greater impact on the healthcare system as the population ages. The relationship between the recovery of functional impairments and frailty status in geriatric care units is still not clear. Simple screening technologies are required in order to operationalize frailty management in this susceptible population due to these restrictions. Aim: The study aims to screen hospitalized older adults for frailty and associated co-morbid conditions in western Gujarat, India. Materials and Methods This is an institutionally based cross-sectional study conducted on the elderly patients (aged 60 years or more) admitted at the tertiary-level government hospital of Jamnagar District of Gujarat State during the period of October 22 to December 22. The assessment was done with a structured questionnaire for FRAIL screen, the Rapid Cognitive Screen (RCS), Charles Co-morbidity Index, Geriatric Depression Scale-5 (GDS-5), and Short Form-12 (SF-12) Health Survey. Results The overall findings of this study reveal that of 124 participants 34 (27%) were frail, 52 (42%) were found to be a likelihood of depression by the GDS, and 29 (23%) were having dementia by RCS, respectively. In our study, we also found a statistically significant association between frailty and dementia (P value < 0.001). Conclusion The present study implies the prevalence of frailty among old age elderly patients and its association with various socio-demographic and co-morbid conditions of the participants. Early identification of frailty and co-morbid conditions can help to prevent adverse health outcomes.
Collapse
Affiliation(s)
- Naresh R. Makwana
- Department of Community Medicine, Shri M. P. Shah Government Medical College, Jamnagar, Gujarat, India
| | - Rohitkumar V. Ram
- Department of Community Medicine, Shri M. P. Shah Government Medical College, Jamnagar, Gujarat, India
| | - M Yogesh
- Department of Community Medicine, Shri M. P. Shah Government Medical College, Jamnagar, Gujarat, India
| |
Collapse
|
3
|
Zhu X, Ding L, Zhang X, Xiong Z. Association of cognitive frailty and abdominal obesity with cardiometabolic multimorbidity among middle-aged and older adults: A longitudinal study. J Affect Disord 2023; 340:523-528. [PMID: 37595895 DOI: 10.1016/j.jad.2023.08.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Cognitive frailty and abdominal obesity are deemed to be important targets for disease prevention. However, a possible cardiometabolic multimorbidity (CMM) link with cognitive frailty and abdominal obesity is unknown. The aim of this study was to investigate the association of cognitive frailty and abdominal obesity with CMM in the middle-aged and older people. METHODS The sample comprised 11,503 participants aged 45 and over from the China Health and Retirement Longitudinal Study (CHARLS) 2011. Cognitive frailty was defined as the coexisting cognitive impairment and physical frailty. Abdominal obesity was assessed using waist circumference. CMM was defined as the presence of two or more cardiometabolic diseases (CMDs), including diabetes, heart disease, and stroke. A total of 9177 participants without CMM recruited from CHARLS 2011 and were followed up in 2018. RESULTS Compared with 0 CMD, coexisting cognitive frailty and abdominal obesity was associated with the risk of 1 CMD (OR: 1.734, 95 % CI: 1.133-2.655), and ≥ 2 CMDs (OR: 7.218, 95%CI: 3.216-16.198). Longitudinal analysis showed that individuals with both cognitive frailty and abdominal obesity (HR: 2.162, 95%CI: 1.032-4.531) were more likely to have new onset CMM than cognitive frailty alone peers (HR: 1.667, 95 % CI: 0.721-3.853). Among the participants with first CMD, the likelihood of CMM was substantially higher in the co-existence of cognitive frailty and abdominal obesity (HR: 3.073, 95%CI: 1.254-7.527) than in the abdominal obesity alone (HR: 1.708, 95%CI: 1.201-2.427). Cognitive frailty alone was not significantly associated with CMM. CONCLUSION Cognitive frailty is not independently associated with the risk of CMM, but cognitive frailty and abdominal obesity together has a greater risk of CMM.
Collapse
Affiliation(s)
- Xinhong Zhu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China.
| | - Linlin Ding
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Xiaona Zhang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Zhenfang Xiong
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| |
Collapse
|
4
|
Marcozzi S, Bigossi G, Giuliani ME, Lai G, Giacconi R, Piacenza F, Malavolta M. Spreading Senescent Cells' Burden and Emerging Therapeutic Targets for Frailty. Cells 2023; 12:2287. [PMID: 37759509 PMCID: PMC10528263 DOI: 10.3390/cells12182287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
The spreading of senescent cells' burden holds profound implications for frailty, prompting the exploration of novel therapeutic targets. In this perspective review, we delve into the intricate mechanisms underlying senescent cell spreading, its implications for frailty, and its therapeutic development. We have focused our attention on the emerging age-related biological factors, such as microbiome and virome alterations, elucidating their significant contribution to the loss of control over the accumulation rate of senescent cells, particularly affecting key frailty domains, the musculoskeletal system and cerebral functions. We believe that gaining an understanding of these mechanisms could not only aid in elucidating the involvement of cellular senescence in frailty but also offer diverse therapeutic possibilities, potentially advancing the future development of tailored interventions for these highly diverse patients.
Collapse
Affiliation(s)
- Serena Marcozzi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy
| | - Giorgia Bigossi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Maria Elisa Giuliani
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Giovanni Lai
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Robertina Giacconi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Francesco Piacenza
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Marco Malavolta
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| |
Collapse
|
5
|
Cipolli GC, de Assumpção D, Borim FSA, Aprahamian I, da Silva Falcão DV, Cachioni M, Batistoni SST, de Melo RC, Corona LP, Neri AL, Xue QL, Yassuda MS. Cognitive Impairment Predicts Sarcopenia 9 Years Later Among Older Adults. J Am Med Dir Assoc 2023:S1525-8610(23)00471-1. [PMID: 37311558 DOI: 10.1016/j.jamda.2023.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the longitudinal association between cognitive impairment and sarcopenia in a sample of Brazilian community-dwelling older adults. DESIGN Nine-year observational prospective study. SETTING AND PARTICIPANTS A total of 521 community-dwelling older adults from 2 Brazilian sites of the Frailty in Brazilian Older Adults (FIBRA in Portuguese) study. METHODS Sarcopenia was defined as low hand-grip strength and low muscle mass. Cognitive impairment was determined at baseline using the Mini-Mental State Examination, with education-adjusted cutoff scores. The logistic regression model was used to assess the association between cognitive impairment and incident sarcopenia after adjusting for gender, age, education, morbidities, physical activity, and body mass index. Inverse probability weighting was applied to correct for sample loss at follow-up. RESULTS The mean age of the study population was 72.7 (±5.6) years, and 365 were women (70.1%). Being 80 years and older (odds ratio [OR], 4.62; 95% CI, 1.38-15.48; P = .013), being under- and overweight (OR, 0.29; 95% CI, 0.11-0.76; P = .012, and OR, 5.12; 95% CI, 2.18-12.01; P < .001, respectively) and having cognitive impairment (OR, 2.44; 95% CI, 1.18-5.04; P = .016) at baseline predicted sarcopenia after 9 years. CONCLUSION AND IMPLICATIONS Cognitive impairment may predict sarcopenia in Brazilian older adults. More studies are necessary to identify the main mechanisms shared by sarcopenia and cognitive decline, which could support the development of prevention interventions.
Collapse
Affiliation(s)
| | - Daniela de Assumpção
- State University of Campinas, Graduate Program in Gerontology, Campinas, SP, Brazil
| | | | - Ivan Aprahamian
- Faculty of Medicine of Jundiaí, Department of Internal Medicine, Research Group on Multimorbidity and Mental Health in Aging, Jundiaí, SP, Brazil
| | | | - Meire Cachioni
- State University of Campinas, Graduate Program in Gerontology, Campinas, SP, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil
| | - Samila Sathler Tavares Batistoni
- State University of Campinas, Graduate Program in Gerontology, Campinas, SP, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil
| | - Ruth Caldeira de Melo
- State University of Campinas, Graduate Program in Gerontology, Campinas, SP, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil
| | - Ligiana Pires Corona
- State University of Campinas, Graduate Program in Gerontology, Campinas, SP, Brazil
| | | | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mônica Sanches Yassuda
- State University of Campinas, Graduate Program in Gerontology, Campinas, SP, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil.
| |
Collapse
|
6
|
Crane B, Nichols E, Carlson M, Deal J, Gross A. Body Mass Index and Cognition: Associations Across
Mid- to Late Life and Gender Differences. J Gerontol A Biol Sci Med Sci 2023; 78:988-996. [PMID: 36638277 PMCID: PMC10235201 DOI: 10.1093/gerona/glad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Higher mid-life body mass index (BMI) is associated with lower late-life cognition. Associations between later-life BMI and cognition are less consistent; evidence suggests reverse causation may play a role. We aimed to characterize associations between BMI and cognition across a wide age range during mid- to late life (55-85 years) and examine whether associations vary by gender. METHODS We used data from the Health and Retirement Study (HRS) (N = 39,153) to examine the association between BMI and 3 cognitive outcomes: cognitive level, cognitive decline, and cognitive impairment. We used a series of linear regression, mixed effects regression, and logistic regression models, adjusting for potential confounders. RESULTS Higher BMI before age 65 (midlife) was associated with lower cognitive performance, faster rates of cognitive decline, and higher odds of cognitive impairment in late life. Averaging across analyses assessing associations between BMI measured before age 60 and late-life cognition, a 5-unit higher level of BMI was associated with a 0.26 point lower cognitive score. Beyond age 65, associations flipped, and higher BMI was associated with better late-life cognitive outcomes. Associations in both directions were stronger in women. Excluding those with BMI loss attenuated findings among women in older ages, supporting the reverse causation hypothesis. CONCLUSIONS In this sample, age 65 represented a critical turning point between mid- and late life for the association between BMI and cognition, which has important implications for recruitment strategies for studies focused on risk factors for late-life cognitive outcomes. Evidence of gender differences raises the need to further investigate plausible mechanisms.
Collapse
Affiliation(s)
- Breanna M Crane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emma Nichols
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alden L Gross
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Sirisegaram L, Owodunni OP, Ehrlich A, Qin CX, Bettick D, Gearhart SL. Validation of the self-reported domains of the Edmonton Frail Scale in patients 65 years of age and older. BMC Geriatr 2023; 23:15. [PMID: 36631769 PMCID: PMC9832416 DOI: 10.1186/s12877-022-03623-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION In the era of virtual care, self-reported tools are beneficial for preoperative assessments and facilitating postoperative planning. We have previously reported the use of the Edmonton Frailty Scale (EFS) as a valid preoperative assessment tool. OBJECTIVE We wished to validate the self-reported domains of the EFS (srEFS) by examining its association with loss of independence (LOI) and mortality. METHODS This is a post-hoc analysis of a single-institution observational study of patients 65 years of age or older undergoing multi-specialty surgical procedures and assessed with the EFS in the preoperative setting. Exploratory data analysis was used to determine the threshold for identifying frailty using the srEFS. Procedures were classified using the Operative Stress Score (OSS) scored 1 to 5 (lowest to highest). Hierarchical Condition Category (HCC) was utilized to risk-adjust. LOI was described as requiring more support at discharge and mortality was defined as death occurring up to 30 days following surgery. Receiver operating characteristic (ROC) curves were used to determine the ability of the srEFS to predict the outcomes of interest in relation to the EFS. RESULTS Five hundred thirty-five patients were included. Exploratory analysis confirmed best positive predictive value for srEFS was greater or equal to 5. Overall, 113 (21 percent) patients were considered high risk for frailty (HRF) and 179 (33 percent) patients had an OSS greater or equal to 5. LOI occurred in 7 percent (38 patients) and the mortality rate was 4 percent (21 patients). ROC analysis showed that the srEFS performed similar to the standard EFS with no difference in discriminatory thresholds for predicting LOI and mortality. Examination of the domains of the EFS not included in the srEFS demonstrated a lack of association between cognitive decline and the outcomes of interest. However, functional status assessed with either the Get up and Go (EFS only) or self-reported ADLs was independently associated with increased risk for LOI. CONCLUSION This study shows that self-reported EFS may be an optional preoperative tool that can be used in the virtual setting to identify patients at HRF. Early identification of patients at risk for LOI and mortality provides an opportunity to implement targeted strategies to improve patient care.
Collapse
Affiliation(s)
- Luxey Sirisegaram
- grid.21107.350000 0001 2171 9311The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA ,grid.39381.300000 0004 1936 8884Schulich School of Medicine, University of Western Ontario, London, ON Canada
| | - Oluwafemi P. Owodunni
- grid.21107.350000 0001 2171 9311Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - April Ehrlich
- grid.21107.350000 0001 2171 9311Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Caroline Xu Qin
- grid.21107.350000 0001 2171 9311Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Dianne Bettick
- grid.21107.350000 0001 2171 9311Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Susan L. Gearhart
- grid.21107.350000 0001 2171 9311Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD USA ,grid.411940.90000 0004 0442 9875Department of Surgery, Johns Hopkins Bayview Medical Center, A Building, 4940 Eastern Avenue, Baltimore, MD 21286 USA
| |
Collapse
|
8
|
Wang W, Si H, Yu R, Qiao X, Jin Y, Ji L, Liu Q, Bian Y, Yu J, Wang C. Effects of reversible cognitive frailty on disability, quality of life, depression, and hospitalization: a prospective cohort study. Aging Ment Health 2022; 26:2031-2038. [PMID: 34889147 DOI: 10.1080/13607863.2021.2011835] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Cognitive frailty, a potentially reversible condition describing the concurrence of physical frailty and mild cognitive impairment (MCI), has been recently proposed to incorporate subjective cognitive decline (SCD), a reversible pre-MCI state with more readily available cognitive reserve, as well as pre-physical frailty. Reversible cognitive frailty has been associated with dementia and mortality. We aimed to examine the association of reversible cognitive frailty with other adverse outcomes including disability, poor quality of life (QOL), depression, and hospitalization. METHODS This was a cohort study with 1-year follow-up among 735 Chinese community-dwelling older adults with intact cognition. Reversible cognitive frailty was operationalized with the presence of pre-physical or physical frailty identified by the Frailty Phenotype and SCD identified by the simplified SCD questionnaire including four self-report cognitive domains of memory, naming, orientation, and mathematical reasoning. Adverse outcomes included incident Activities of Daily Living (ADL)-Instrumental ADL (IADL) disability, poor physical, mental and overall QOL, depression, and hospitalization over 1-year follow-up. RESULTS The prevalence of reversible cognitive frailty was 27.8%. Participants with reversible cognitive frailty had higher risk of the incidence of ADL-IADL disability, poor physical QOL, poor mental QOL, poor overall QOL, and depression (Odds Ratios: 1.67-4.38, P < 0.05), but not higher risk of hospitalization over 1-year follow-up. CONCLUSION Reversible cognitive frailty was not uncommon and associated with incident disability, poor QOL, and depression among community-dwelling older adults. Early identification of reversible cognitive frailty can facilitate targeted interventions and may promote independence in older adults. UNLABELLED Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2011835.
Collapse
Affiliation(s)
- Wenyu Wang
- School of Nursing, Peking University, Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, Beijing, China
| | - Ruby Yu
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Xiaoxia Qiao
- School of Nursing, Peking University, Beijing, China
| | - Yaru Jin
- School of Nursing, Peking University, Beijing, China
| | - Lili Ji
- School of Nursing, Peking University, Beijing, China
| | - Qinqin Liu
- School of Nursing, Peking University, Beijing, China
| | - Yanhui Bian
- School of Nursing, Peking University, Beijing, China
| | - Jiaqi Yu
- School of Nursing, Peking University, Beijing, China
| | - Cuili Wang
- School of Nursing, Peking University, Beijing, China
| |
Collapse
|
9
|
Cao X, Chen C, Zhang J, Xue QL, Hoogendijk EO, Liu X, Li S, Wang X, Zhu Y, Liu Z. Aging metrics incorporating cognitive and physical function capture mortality risk: results from two prospective cohort studies. BMC Geriatr 2022; 22:378. [PMID: 35484496 PMCID: PMC9052591 DOI: 10.1186/s12877-022-02913-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aging metrics incorporating cognitive and physical function are not fully understood, hampering their utility in research and clinical practice. This study aimed to determine the proportions of vulnerable persons identified by three existing aging metrics that incorporate cognitive and physical function and the associations of the three metrics with mortality. METHODS We considered three existing aging metrics including the combined presence of cognitive impairment and physical frailty (CI-PF), the frailty index (FI), and the motoric cognitive risk syndrome (MCR). We operationalized them using data from the China Health and Retirement Longitudinal Study (CHARLS) and the US National Health and Nutrition Examination Survey (NHANES). Logistic regression models or Cox proportional hazards regression models, and receiver operating characteristic curves were used to examine the associations of the three metrics with mortality. RESULTS In CHARLS, the proportions of vulnerable persons identified by CI-PF, FI, and MCR were 2.2, 16.6, and 19.6%, respectively. Each metric predicted mortality after adjustment for age and sex, with some variations in the strength of the associations (CI-PF, odds ratio (OR) (95% confidence interval (CI)) 2.87 (1.74-4.74); FI, OR (95% CI) 1.94 (1.50-2.50); MCR, OR (95% CI) 1.27 (1.00-1.62)). CI-PF and FI had additional predictive utility beyond age and sex, as demonstrated by integrated discrimination improvement and continuous net reclassification improvement (all P < 0.001). These results were replicated in NHANES. CONCLUSIONS Despite the inherent differences in the aging metrics incorporating cognitive and physical function, they consistently capture mortality risk. The findings support the incorporation of cognitive and physical function for risk stratification in both Chinese and US persons, but call for caution when applying them in specific study settings.
Collapse
Affiliation(s)
- Xingqi Cao
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health; National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jingyun Zhang
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Qian-Li Xue
- Department of Medicine Division of Geriatric Medicine and Gerontology and Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam UMC - location VU University Medical Center, Amsterdam, the Netherlands
| | - Xiaoting Liu
- School of Public Affairs, Zhejiang University, Zhejiang, Hangzhou, China
| | - Shujuan Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Wang
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, and Human Phenome Institute, Fudan University, Shanghai, China.
| | - Yimin Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China.
| | - Zuyun Liu
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China.
| |
Collapse
|
10
|
Bortone I, Sardone R, Lampignano L, Castellana F, Zupo R, Lozupone M, Moretti B, Giannelli G, Panza F. How gait influences frailty models and health-related outcomes in clinical-based and population-based studies: a systematic review. J Cachexia Sarcopenia Muscle 2021; 12:274-297. [PMID: 33590975 PMCID: PMC8061366 DOI: 10.1002/jcsm.12667] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/30/2020] [Accepted: 12/16/2020] [Indexed: 12/20/2022] Open
Abstract
Aging is often associated with a decline in physical function that eventually leads to loss of autonomy in activities of daily living (ADL). Walking is a very common ADL, important for main determinants of quality of life in older age, and it requires the integration of many physiological systems. Gait speed has been described as the 'sixth vital sign' because it is a core indicator of health and function in aging and disease. We reviewed original studies up to June 2020 that assessed frailty in both longitudinal and cross-sectional observational studies, paying particular attention to how gait is measured in older population and how the gait parameter adopted may influence the estimated frailty models and the health-related outcomes of the various studies (i.e. clinical, cognitive, physical, and nutritional outcomes). Eighty-five studies met the search strategy and were included in the present systematic review. According to the frailty tools, more than 60% of the studies used the physical phenotype model proposed by Fried and colleagues, while one-third referred to multi-domain indexes or models and only 5% referred to other single-domain frailty models (social or cognitive). The great heterogeneity observed in gait measurements and protocols limited the possibility to directly compare the results of the studies and it could represent an important issue causing variability in the different outcome measures in both clinical-and population-based settings. Gait appeared to be an indicator of health and function also in frail older adults, and different gait parameters appeared to predict adverse health-related outcomes in clinical, cognitive, and physical domains and, to a lesser extent, in nutritional domain. Gait has the potential to elucidate the common basic mechanisms of cognitive and motor decline. Advances in technology may extend the validity of gait in different clinical settings also in frail older adults, and technology-based assessment should be encouraged. Combining various gait parameters may enhance frailty prediction and classification of different frailty phenotypes.
Collapse
Affiliation(s)
- Ilaria Bortone
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Rodolfo Sardone
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Luisa Lampignano
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Fabio Castellana
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Roberta Zupo
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Madia Lozupone
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Biagio Moretti
- Orthopaedics and Trauma Unit, Department of Basic Medicine, Neuroscience, and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Gianluigi Giannelli
- Scientific DirectionNational Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Francesco Panza
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| |
Collapse
|
11
|
Xue QL, Bandeen-Roche K, Tian J, Kasper JD, Fried LP. Progression of Physical Frailty and the Risk of All-Cause Mortality: Is There a Point of No Return? J Am Geriatr Soc 2021; 69:908-915. [PMID: 33368158 PMCID: PMC8049969 DOI: 10.1111/jgs.16976] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/04/2020] [Accepted: 11/19/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To investigate the rate and patterns of accumulation of frailty manifestations in relationship to all-cause mortality and whether there is a point in the progression of frailty beyond which the process becomes irreversible and death becomes imminent (a.k.a. point of no return). DESIGN Longitudinal observational study. SETTING Community or a non-nursing home residential care setting. PARTICIPANTS Two thousand five hundred and fifty seven robust older adults identified at baseline in 2011 with follow-up for all-cause mortality between 2011 and 2018. MEASUREMENTS Frailty was measured by the physical frailty phenotype. Cox models were used to study the relationships of the number of frailty criteria (0-5) at each point in time and its accumulation patterns with all-cause mortality. Markov state-transition models were used to study annual transitions between health states (i.e., frailty, recovery, and death) after becoming frail among those with frailty onset (n = 373). RESULTS There was a nonlinear association between greater number of frailty criteria and increasing risk of mortality, with a notable risk acceleration after having accumulated all five criteria (hazard ratio (HR) = 32.6 vs none, 95% confidence interval (CI) = 15.7-67.5). In addition, the risk of one-year mortality tripled, and the likelihood of recovery (i.e., reverting to be robust or pre-frail) halved among those with five frailty criteria compared to those with three or four criteria. A 50% increase in mortality risk was also associated with frailty onset without (vs with) a prior history of pre-frailty (HR = 1.51, 95% CI = 1.20-1.90). CONCLUSION Both the number and rate of accumulation of frailty criteria were associated with mortality risk. Although there was insufficient evidence to declare a point of no return, having all five-frailty criteria signals the beginning of a transition toward a point of no return. Ongoing monitoring of frailty progression could aid clinical and personal decision-making regarding timing of intervention and eventual transition from curative to palliative care.
Collapse
Affiliation(s)
- Qian-Li Xue
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Karen Bandeen-Roche
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Jing Tian
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Judith D. Kasper
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Linda P. Fried
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| |
Collapse
|
12
|
Bandeen-Roche K, Gross AL, Varadhan R, Buta B, Carlson MC, Huisingh-Scheetz M, Mcadams-Demarco M, Piggott DA, Brown TT, Hasan RK, Kalyani RR, Seplaki CL, Walston JD, Xue QL. Principles and Issues for Physical Frailty Measurement and Its Clinical Application. J Gerontol A Biol Sci Med Sci 2021; 75:1107-1112. [PMID: 31287490 DOI: 10.1093/gerona/glz158] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION "Frailty" has attracted attention for its promise of identifying vulnerable older adults, hence its potential use to better tailor geriatric health care. There remains substantial controversy, however, regarding its nature and ascertainment. Recent years have seen a proliferation of frailty assessment methods. We argue that the development of frailty assessments should be grounded in "validation"-the process of substantiating that a measurement accurately and precisely measures what it intends, identify unresolved measurement issues, and highlight measurement-related considerations for clinical practice. METHODS Principles for validating frailty measures are elucidated. We follow principles-articulated, for example, by Borsboom-in which a construct must be clearly defined and then analyses undertaken to substantiate that a measurement accurately and precisely measures what it intends. Key elements are content validity, criterion validity, and construct validity, with an emphasis on the latter. RESULTS We illustrate the principles for a physical frailty phenotype construct. CONCLUSIONS Unresolved conceptual issues include the roles of intersecting concepts such as cognition, disease severity, and disability in frailty measurement, conceptualization of frailty as a state versus a continuum, and the potential need for dynamic measures and systems concepts in furthering understanding of frailty. Clinical considerations include needs to distinguish interventions designed to address frailty "symptoms" versus underlying physiology, improve "prefrailty" measures intended to screen individuals early in their frailty progression, address feasibility demands, and further visioning followed by rigorous efficacy research to address the landscape of potential uses of frailty assessment in clinical practice.
Collapse
Affiliation(s)
- Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alden L Gross
- Department of Epidemiology, Baltimore, Maryland.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ravi Varadhan
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brian Buta
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michelle C Carlson
- Department of Epidemiology, Baltimore, Maryland.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Megan Huisingh-Scheetz
- Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago Medicine, Illinois
| | | | - Damani A Piggott
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Baltimore, Maryland
| | - Todd T Brown
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rani K Hasan
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rita R Kalyani
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Jeremy D Walston
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Qian-Li Xue
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Baltimore, Maryland
| |
Collapse
|
13
|
Fried LP, Cohen AA, Xue QL, Walston J, Bandeen-Roche K, Varadhan R. The physical frailty syndrome as a transition from homeostatic symphony to cacophony. NATURE AGING 2021; 1:36-46. [PMID: 34476409 PMCID: PMC8409463 DOI: 10.1038/s43587-020-00017-z] [Citation(s) in RCA: 197] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/07/2020] [Indexed: 12/14/2022]
Abstract
Frailty in aging marks a state of decreased reserves resulting in increased vulnerability to adverse outcomes when exposed to stressors. This Perspective synthesizes the evidence on the aging-related pathophysiology underpinning the clinical presentation of physical frailty as a phenotype of a clinical syndrome that is distinct from the cumulative-deficit-based frailty index. We focus on integrating the converging evidence on the conceptualization of physical frailty as a state, largely independent of chronic diseases, that emerges when the dysregulation of multiple interconnected physiological and biological systems crosses a threshold to critical dysfunction, severely compromising homeostasis. Our exegesis posits that the physiology underlying frailty is a critically dysregulated complex dynamical system. This conceptual framework implies that interventions such as physical activity that have multisystem effects are more promising to remedy frailty than interventions targeted at replenishing single systems. We then consider how this framework can drive future research to further understanding, prevention and treatment of frailty, which will likely preserve health and resilience in aging populations.
Collapse
Affiliation(s)
- Linda P. Fried
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Alan A. Cohen
- Groupe de recherche PRIMUS, Department of Family Medicine, Université de Sherbrooke, Quebec City, Quebec, Canada
| | - Qian-Li Xue
- Johns Hopkins Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeremy Walston
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Karen Bandeen-Roche
- Johns Hopkins Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- These authors jointly supervised this work: Karen Bandeen-Roche, Ravi Varadhan
| | - Ravi Varadhan
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
- These authors jointly supervised this work: Karen Bandeen-Roche, Ravi Varadhan
| |
Collapse
|
14
|
Ge ML, Carlson MC, Bandeen-Roche K, Chu NM, Tian J, Kasper JD, Xue QL. U.S. National Profile of Older Adults with Cognitive Impairment Alone, Physical Frailty Alone, and Both. J Am Geriatr Soc 2020; 68:2822-2830. [PMID: 32860219 DOI: 10.1111/jgs.16769] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES To obtain national and regional estimates of prevalence of frailty with or without cognitive impairment, and cognitive impairment with or without frailty among older adults in the United States, and to identify profiles of characteristics that distinguish their joint versus separate occurrence. DESIGN Cross-sectional. SETTING Community or non-nursing home residential care settings. PARTICIPANTS A U.S. nationally representative sample of 7,497 older adults aged 65 and older from the National Health and Aging Trends Study. MEASUREMENTS Frailty was measured by the physical frailty phenotype. Cognitive impairment was assessed by cognitive performance testing of executive function and memory or by proxy reports. Multinomial logistic regression was used to identify profiles of demographic, socioeconomic, health, behavioral, and psychosocial characteristics that distinguish four subgroups: not-frail and cognitively intact ("neither"), not-frail and cognitively impaired ("Cog. only"), frail and cognitively intact ("frailty only"), and frail and cognitively impaired ("both"). RESULTS The prevalence of "Cog. only," "frailty only," and "both" was 25.5%, 5.6%, and 8.7%, respectively. Individuals with"frailty only" had the highest prevalence of obesity, current smoking, comorbidity, lung disease, and history of surgery. The "both" group had the highest prevalence of dementia, depression, cardiovascular diseases, and disability. No significant differences were found between the "Cog. only" group and the "neither" group with respect to history of surgery and comorbidity burden. The prevalence of dementia in the "Cog. only" was less than half of that in the "both" group. CONCLUSION The finding of sizable subgroups having physical frailty but not cognitive impairment, and vice versa, suggests that the two cannot be considered necessarily as antecedent or sequela of one another. The study provided empirical data supporting the prioritization of comorbidity, obesity, surgery history, and smoking status in clinical screening of frailty and cognitive impairment before formal diagnostic assessments.
Collapse
Affiliation(s)
- Mei-Ling Ge
- The Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, China
| | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Karen Bandeen-Roche
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jing Tian
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Qian-Li Xue
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
15
|
Gearhart SL, Do EM, Owodunni O, Gabre-Kidan AA, Magnuson T. Loss of Independence in Older Patients after Operation for Colorectal Cancer. J Am Coll Surg 2020; 230:573-582. [PMID: 32220448 DOI: 10.1016/j.jamcollsurg.2019.12.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Disease-free survival is the cornerstone for colorectal cancer outcomes. Maintenance of independence may represent the preferred cancer outcome in older patients. Frailty and cognitive impairment are associated with adverse clinical outcomes after operation in patients ≥65 years. The aim of this study was to determine the impact of frailty and cognitive impairment on loss of independence (LOI) among colorectal cancer patients. STUDY DESIGN From 2016 to 2018, patients undergoing operation for colorectal cancer and having geriatric-specific American College of Surgeons NSQIP variables recorded were included. Frailty was assessed using the modified frailty index. Loss of independence was defined by the need for assistance with activities of daily living. Complications were assessed using the Clavien-Dindo (CD) scoring system. Multivariable analyses examining LOI, length of stay (LOS), and 30-day postoperative complication and readmission were performed. RESULTS There were 1,676 patients included. Preoperatively, 118 (7%) patients reported cognitive impairment, 388 (23%) patients used a mobility aid, and 82 (5%) patients were partially or totally dependent. Loss of independence upon discharge was seen in 344 (20.5%) patients and was independently associated with an increase in LOS (incidence rate ratio [IRR] 1.44, 95% CI 1.30 to 1.59) and major complication (odds ratio [OR] 1.86, 95% CI 1.36 to 2.53). Risk factors predictive of LOI upon discharge were increasing age, cognitive impairment, use of mobility aid, and postoperative delirium. In patients ≥80 years old, 93 (18%) had LOI at 30 days. Risk factors predictive of LOI at 30 days included a preoperative mobility aid, postoperative delirium, and the need for a new mobility aid. CONCLUSIONS One of 5 older patients undergoing operation for colorectal cancer experience LOI, and risk factors include a decline in cognition and mobility. Future studies should evaluate risks for long-term LOI and explore interventions to optimize this patient population.
Collapse
Affiliation(s)
- Susan L Gearhart
- Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD.
| | - Eric M Do
- Department of Geriatric Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Oluwafemi Owodunni
- Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | | | - Thomas Magnuson
- Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD
| |
Collapse
|